Tricuspid Annular Plane Systolic Excursion Is a Robust Outcome Measure in Systemic Sclerosis-Associated Pulmonary Arterial Hypertension

J Rheumatol. 2011 Nov;38(11):2410-8. doi: 10.3899/jrheum.110512. Epub 2011 Oct 1.

Abstract

Objective: The tricuspid annular plane systolic excursion (TAPSE) strongly reflects right ventricular (RV) function and predicts survival in idiopathic pulmonary arterial hypertension (PAH). But its role in systemic sclerosis (SSc)-associated PAH has not been established. Our objective was to validate the TAPSE in the assessment of RV function and prediction of survival in SSc-PAH.

Methods: Fifty consecutive patients with SSc-PAH who underwent echocardiography with TAPSE measurement within 1 h of clinically indicated right heart catheterization were followed prospectively. The relationship between TAPSE and measures of RV function and measures of survival was assessed.

Results: The majority of the cohort were women in New York Heart Association class III/IV with severe PAH (mean cardiac index 2.4 ± 0.8 l/min/m(2)). RV function was significantly impaired (mean cardiac index 2.1 ± 0.7 vs 2.9 ± 0.8 l/min/m(2); p < 0.01) and RV afterload was significantly greater (mean pulmonary vascular resistance 11.1 ± 5.1 vs 5.8 ± 2.5 Wood units; p < 0.01) in subjects with a TAPSE ≤ 1.7 cm. The proportion surviving in the low TAPSE group was significantly lower [0.56 (95% CI 0.37-0.71) and 0.46 (95% CI 0.28-0.62) vs 0.87 (95% CI 0.55-0.96) and 0.79 (95% CI 0.49-0.93), 1- and 2-year survival, respectively]. TAPSE ≤ 1.7 cm conferred a nearly 4-fold increased risk of death (HR 3.81, 95% CI 1.31-11.1, p < 0.01).

Conclusion: TAPSE is a robust measure of RV function and strongly predicts survival in patients with PAH-SSc. Future studies are needed to identify the responsiveness of TAPSE to PAH-specific therapy and to assess its diagnostic utility in PAH-SSc.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Blood Pressure / physiology
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Heart Ventricles / diagnostic imaging*
  • Humans
  • Hypertension, Pulmonary / etiology*
  • Hypertension, Pulmonary / mortality
  • Hypertension, Pulmonary / physiopathology*
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care*
  • Predictive Value of Tests
  • Prospective Studies
  • Regional Blood Flow / physiology
  • Reproducibility of Results
  • Scleroderma, Systemic / complications*
  • Scleroderma, Systemic / mortality
  • Scleroderma, Systemic / physiopathology*
  • Sensitivity and Specificity
  • Survival Rate
  • Systole / physiology
  • Tricuspid Valve / diagnostic imaging*
  • Tricuspid Valve / physiology
  • Ultrasonography
  • Vascular Resistance / physiology
  • Ventricular Function, Right / physiology*